| NPI | 1518142371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 783952) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MA 267815) |
| Enumeration Date | 2007-12-29 |
| Last Update Date | 2024-04-08 |