| NPI | 1629342548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 8055787-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 8055787-3102) |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2019-06-18 |