| NPI | 1447371596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 002600) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 002600) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2015-10-14 |