| NPI | 1407288459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5006328) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5006328) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2024-04-04 |