| NPI | 1720347065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71005965A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 281124) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN181191) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024174950) | |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2022-06-20 |