| NPI | 1003162215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 8339822-4405) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP4660) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2020-06-01 |