| NPI | 1982957924 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R235680) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R235680) | 
| 363LA2100X Nurse Practitioner, Acute Care (Licence: DE LP-0010909) | |
| 363L00000X Nurse Practitioner (Licence: DE LP-0010909) | |
| Enumeration Date | 2012-10-15 | 
| Last Update Date | 2025-09-15 |