| NPI | 1306452347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AR 124241) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: AR 124241) |
| 363LF0000X Nurse Practitioner Family (Licence: AR 124241) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: AR 124241) | |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: AR 124241) | |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2023-07-25 |