| NPI | 1659334423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5006044) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM R45111) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NM CNP01073) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2014-03-04 |