| NPI | 1033487806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5005436) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5005436) |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2022-04-28 |