| NPI | 1154781268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VT 101.0126557) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 821264) |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2017-05-10 |