| NPI | 1184933145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AR A03633) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY F430548-1) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA NP19209) | |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2012-04-03 |