| NPI | 1093797169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA F1105011) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: LA APO 4828) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2024-05-22 |