| NPI | 1306239660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95037713) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2275289) |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2026-01-26 |