| NPI | 1003230780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: SC 18671) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: SC 18671) |
| 363LF0000X Nurse Practitioner Family (Licence: SC 18671) | |
| Enumeration Date | 2014-02-14 |
| Last Update Date | 2014-03-06 |