| NPI | 1295738706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS 893878) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AR A001384) |
| 363L00000X Nurse Practitioner (Licence: AR A001384) | |
| 363L00000X Nurse Practitioner (Licence: TN 19099) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 19099) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 893878) | |
| Enumeration Date | 2005-05-30 |
| Last Update Date | 2025-05-06 |