| NPI | 1841510419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5007381) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN607237) |
| 163W00000X Registered Nurse (Licence: NC 274119) | |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2014-12-23 |