| NPI | 1992138382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP7279) |
| Additional Taxonomies | 282NC0060X General Acute Care Hospital, Critical Access (Licence: UT 6743505-4405) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2020-09-24 |