| NPI | 1437437977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA APO6644) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN114079) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2016-09-01 |