| NPI | 1194029777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP2975042) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 7139-33) |
| Enumeration Date | 2010-12-22 |
| Last Update Date | 2023-03-07 |