| NPI | 1063440402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 900170) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 110799) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2019-06-12 |