| NPI | 1043525744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 111172) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A096950) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2022-07-21 |