| NPI | 1306190566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA TP004573P) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: PA TP004573P) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2021-12-16 |