| NPI | 1811171408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS R878258) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ARNP1604312) |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2010-07-09 |