| NPI | 1164738399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-54594) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: NM CNS-00220) |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2020-09-09 |