| NPI | 1184060980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE 111602) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 68507) |
| 363L00000X Nurse Practitioner (Licence: IA A133921) | |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2025-03-11 |