| NPI | 1194748152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC1500X Nurse Practitioner, Community Health (Licence: MT NUR-APRN-LIC-100240) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MT 17898) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2022-02-24 |