| NPI | 1790072551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: HI APRN-1940) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 279971) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2016-03-08 |