| NPI | 1306259718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: ND R49699) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: ND R49699) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: ND R49699) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2025-07-11 |