| NPI | 1508833278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 3143) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 003189) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2022-05-19 |