| NPI | 1194904193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA AP05303) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP05303) |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2021-03-25 |