| NPI | 1174792287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP4337) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP2727) |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2012-09-04 |