| NPI | 1053483172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OK R0062092) |
| Additional Taxonomies | 163WN0300X Registered Nurse Nephrology (Licence: OK ROO62092) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2022-02-21 |