| NPI | 1750303178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: NC 5009127) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP1701352) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2018-04-05 |