| NPI | 1245687748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA AP08955) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN128460) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2016-07-21 |