| NPI | 1639104565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PR 1653) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: PR 014382) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2013-06-07 |