| NPI | 1275086084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD RN227882) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NV APRN002295) |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2021-12-30 |