| NPI | 1245968973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024185025) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R213897) |
| Enumeration Date | 2022-08-10 |
| Last Update Date | 2022-11-23 |