| NPI | 1790088623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 18958) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704260109) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2014-08-27 |