| NPI | 1831597202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MS 889586) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: MS R889586) |
| 363LF0000X Nurse Practitioner Family (Licence: LA AP08073) | |
| 363LF0000X Nurse Practitioner Family (Licence: MS R889586) | |
| 363LA2100X Nurse Practitioner Acute Care (Licence: MS 889586) | |
| 363LA2100X Nurse Practitioner Acute Care (Licence: LA AP08073) | |
| 363L00000X Nurse Practitioner (Licence: LA AP08073) | |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2022-09-27 |