| NPI | 1942660980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AR A004705) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AR ATP-000931) |
| Enumeration Date | 2016-03-03 |
| Last Update Date | 2016-04-07 |