| NPI | 1982231312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 8167809-4405) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 8167809-4405) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-02-13 |