| NPI | 1265464903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5001551) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 159088) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2022-09-21 |