| NPI | 1568901510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2017009159) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KS 77575) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2017-05-23 |