| NPI | 1558484550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 670513) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 16228) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2007-07-09 |