| NPI | 1336574565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024171326) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0001247949) |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2024-07-20 |