| 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 |