| NPI | 1154568376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 1229) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: AK 19840) |
| Enumeration Date | 2009-01-09 |
| Last Update Date | 2018-03-17 |