| NPI | 1982986279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: TN 15965) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 10740377-4405) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2025-08-05 |