| NPI | 1942943923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11019178) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 17431-33) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2026-01-06 |