| NPI | 1205218724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024172702) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TN 170644) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 20091) | |
| Enumeration Date | 2015-06-20 |
| Last Update Date | 2015-06-29 |