| NPI | 1326330150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA AP06427) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA RN114042) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2011-05-12 |