| NPI | 1538518485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2016010231) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KS 53-77212-061) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2016-06-10 |