| NPI | 1376778803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: MA RN2258970) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: FL ARNP9220338) |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2010-09-11 |