| NPI | 1215387907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NE 112026) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IA H144157) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2024-05-23 |