| NPI | 1073806246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R875413) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS R875413) |
| Enumeration Date | 2011-05-22 |
| Last Update Date | 2014-01-17 |