| NPI | 1386085629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R253541) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 17192) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209011165) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 430878) | |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2022-08-10 |