| NPI | 1013949759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5005702) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 661) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5005702) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2024-10-16 |