| NPI | 1720261365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 14210) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN185322) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN185322) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2012-07-30 |