| NPI | 1770953432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5017857) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5017857) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0000000000) | |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2026-06-10 |