| NPI | 1518161322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS R770242) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 16127) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2007-08-21 |