| NPI | 1174046700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP09526) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA AP09526) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2017-10-30 |