| NPI | 1356385504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: TX 578145) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 578145) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2014-05-08 |