| NPI | 1740049493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID 78892) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: ID 78892) |
| Enumeration Date | 2024-03-15 |
| Last Update Date | 2025-03-17 |