| NPI | 1629337001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024192057) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 50149343) |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2024-12-13 |