| NPI | 1326874074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 337695) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 8991411-4405) |
| Enumeration Date | 2024-09-10 |
| Last Update Date | 2026-04-09 |