| NPI | 1003151945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA AP07104) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 854822) |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2018-03-17 |