| NPI | 1225348238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA AP06227) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA RN102659) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 905040) | |
| Enumeration Date | 2010-10-13 |
| Last Update Date | 2023-01-04 |