| NPI | 1912335910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NH 042632-23) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NH 042632-23) |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2018-12-20 |