| NPI | 1114354727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 79573) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: ME CNP231290) |
| Enumeration Date | 2013-09-28 |
| Last Update Date | 2023-10-25 |