| NPI | 1194198606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 3009896) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 20532) |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2016-05-31 |