| NPI | 1437795739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OK M116526) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: NM RN-89481) |
| 163WH1000X Registered Nurse Hospice (Licence: NM RN-89481) | |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2019-12-26 |