| NPI | 1710295365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 215644-4405) |
| Additional Taxonomies | 163WE0900X Registered Nurse, Enterostomal Therapy (Licence: UT 2156443102) |
| 163WW0000X Registered Nurse, Wound Care (Licence: UT 2156443102) | |
| 163WX1500X Registered Nurse, Ostomy Care (Licence: UT 2156443102) | |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2012-12-05 |