| NPI | 1649222910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 56320) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 7045) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN0000007045) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2019-08-07 |