| NPI | 1831656362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 18017) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2018044783) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2026-05-26 |