| NPI | 1841441243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 200850137NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 18292) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2008-10-02 |