| NPI | 1417284175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OR 201150020NP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TN 14568) |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2011-06-17 |