| NPI | 1487476727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95033455) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1100293) |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2025-03-12 |