| NPI | 1235461419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5004656) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MN 7394) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2020-09-25 |