| NPI | 1487127213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 12098) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 24934) |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2026-02-03 |