| NPI | 1245635622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NM CNP-58760) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: FL ARNP9388145) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2023-09-19 |