| NPI | 1326224809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 13167) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 6075P) |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2011-06-28 |