| NPI | 1144614165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 878547) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS R878547) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2022-05-02 |