| NPI | 1386907996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71004052A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71004052A) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2021-06-11 |