| NPI | 1881384766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024189656) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0024189656) |
| Enumeration Date | 2023-05-12 |
| Last Update Date | 2024-09-25 |