| NPI | 1316162662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95001902) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY F430331-1) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2021-01-25 |