| NPI | 1134428923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 19344) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: SC 69630) |
| 164W00000X Licensed Practical Nurse (Licence: SC PR27111) | |
| Enumeration Date | 2011-03-20 |
| Last Update Date | 2016-09-01 |