| NPI | 1861206229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: UT 9256356-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 9256356-3102) |
| Enumeration Date | 2025-02-05 |
| Last Update Date | 2025-07-02 |