| NPI | 1043669427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP11259) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R192443) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2019-12-02 |