| NPI | 1669228078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5020665) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 259225) |
| Enumeration Date | 2024-04-26 |
| Last Update Date | 2025-04-24 |