| NPI | 1740646082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: UT 14284171-4405) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NH 071245-23) |
| Enumeration Date | 2015-12-31 |
| Last Update Date | 2026-06-23 |