| NPI | 1477310001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ15425200) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 14813-33) |
| 363L00000X Nurse Practitioner (Licence: WI 14813) | |
| Enumeration Date | 2024-02-29 |
| Last Update Date | 2026-08-11 |