| NPI | 1750309332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5008214) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM R51146) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CO 167292) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 624662) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2019-04-09 |