| NPI | 1750731535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-134395) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-134395) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2016-06-13 |