| NPI | 1003889080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 200786) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 143931) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2020-10-30 |