| NPI | 1992039242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: LA AP 05383) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: LA RN107719) |
| Enumeration Date | 2009-09-18 |
| Last Update Date | 2010-05-10 |