| NPI | 1861876047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 30 20011223X) |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2016-04-04 |