| NPI | 1710061676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024165516) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024165516) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2022-12-30 |