| NPI | 1205037272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 200950129NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN8204) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2020-11-19 |