| NPI | 1215966569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-061723) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 1-061723) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2023-06-07 |