| NPI | 1295176410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: UT 6820738-8900) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: UT 6820738-4405) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2013-08-19 |