| NPI | 1669798286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024175251) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: ID NP-963A) |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2024-04-22 |