| NPI | 1144524430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CA 19333) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: NH 083521-23) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: MD R193733) | |
| Enumeration Date | 2011-01-01 |
| Last Update Date | 2023-04-07 |