| NPI | 1972020410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71018254A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9339943) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9339943) | |
| 363L00000X Nurse Practitioner (Licence: CA 95014501) | |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2026-06-24 |