| NPI | 1215451901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD AC008160) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: DE LP-0010546) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2026-01-14 |