| NPI | 1528582186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AR A005278) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AR A005278) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2019-09-18 |