| NPI | 1609050087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AR A003071) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA AP05311) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2018-12-13 |