| NPI | 1831114636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 430277) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP141752) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: HI APRN-831) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP9374582) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP141752) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OH 18554) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2023-12-20 |