| NPI | 1689988552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5014604) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 2005005314-28) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R213855) | |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2021-10-27 |