| NPI | 1487945952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA 60280503) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209.006502) |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2012-04-09 |