| NPI | 1346865920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NY 309654) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: IN 71013344A) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2023-01-20 |