| NPI | 1407936800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 960061) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024167082) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0017138782) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-12-07 |