| NPI | 1881873487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: HI NP1196) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA NP17256) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2010-03-19 |