| NPI | 1245431493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 862029) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS R862029) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MS R862029) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2020-07-08 |