| NPI | 1932979994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP033518) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1135940) |
| Enumeration Date | 2024-01-02 |
| Last Update Date | 2026-04-30 |