| NPI | 1144573197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5005928) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5005928) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5005928) | |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2024-07-15 |