| NPI | 1043614605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP60590908) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431188) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN242399) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95000568) | |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2019-12-05 |