| NPI | 1033507876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95004482) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: RI APRN00014) |
| 363L00000X Nurse Practitioner (Licence: MA RN2265262) | |
| Enumeration Date | 2015-01-01 |
| Last Update Date | 2022-03-29 |