| NPI | 1093761652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MT 100188) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MT RN16696) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2023-11-27 |