| NPI | 1346296027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA AP04908) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: LA AP04908) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2021-04-06 |