| NPI | 1164851069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP60721654) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP5125) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NM CNP-02291) | |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2017-03-01 |