| NPI | 1851685580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: KS 53-75358-091) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2011006714) |
| Enumeration Date | 2011-05-28 |
| Last Update Date | 2011-12-19 |