| NPI | 1881751840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NC 065421) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 600095) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2007-07-09 |