| NPI | 1568130623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD AC005138) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 28643) |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2025-01-07 |