| NPI | 1760961783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024194477) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9310666) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024194477) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL APRN9310666) | |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2025-10-30 |