| NPI | 1518397983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 005610) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 005610) |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2025-03-04 |