| NPI | 1013340744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: LA AP07380) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN124873) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2024-04-09 |