| NPI | 1689645020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 2590432) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: KY 1067675) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2015-05-21 |