| NPI | 1093148769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CT 005443) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 005443) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2018-07-18 |