| NPI | 1184064131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024175543) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704246058) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9438200) | |
| Enumeration Date | 2013-07-04 |
| Last Update Date | 2020-08-17 |