| NPI | 1164810164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA AP07916) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP07916) |
| Enumeration Date | 2014-12-30 |
| Last Update Date | 2024-05-07 |