| NPI | 1063689248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5006600) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 304565) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2024-01-22 |