| NPI | 1316378458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-103917) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD AC001252) |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2020-06-30 |