| NPI | 1609208271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71004544A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71004544A) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2025-09-22 |