| NPI | 1710358395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: DE LP-0010755) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DE LP-0010755) |
| 163W00000X Registered Nurse (Licence: DE L1-0073431) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95003204) | |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2025-10-06 |