| NPI | 1295376101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11008204) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95015868) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2019038218) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1094748) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 202207183NP-PP) | |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2024-05-23 |