| NPI | 1124036728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: SC APRN 2202) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: SC APRN 2202) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2023-08-24 |