| NPI | 1922230747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 359079) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 359079) |
| Enumeration Date | 2009-08-12 |
| Last Update Date | 2009-08-12 |