| NPI | 1811027055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: OR 201050041NP) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: NJ 26NR11867300) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: NJ 26NJ00142100) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: WA AP60120714) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: FL ARNP9261574) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2013-10-21 |