| NPI | 1548895956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 239415) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024178964) |
| 363L00000X Nurse Practitioner (Licence: NC 5016726) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024178964) | |
| Enumeration Date | 2020-03-05 |
| Last Update Date | 2023-02-02 |