| NPI | 1114009966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R867244) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: MS R867244) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: MS R867244) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2024-01-29 |