| NPI | 1700314085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 6994562-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 6994562-4405) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2025-01-30 |