| NPI | 1619392925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP030467) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11021204) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: GA APRN-NP205388) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ15171500Or) | |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2025-10-08 |