| NPI | 1205144201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP08766) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN151719) |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2025-01-31 |