| NPI | 1356685374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: PA SP012526) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: PA SP014682) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2015-10-06 |