| NPI | 1467617076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 901877) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 0000099304) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 13503) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MS 901877) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 13503) | |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2018-03-17 |