| NPI | 1245711084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5015473) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024176669) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5015473) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024176669) | |
| 363L00000X Nurse Practitioner (Licence: NC 5015473) | |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2024-08-19 |