| NPI | 1235134776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SM0705X Clinical Nurse Specialist, Medical-Surgical (Licence: MO 2000164066) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: KS 74751) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2018-03-17 |