| NPI | 1306514385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: VA 0024187382) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: NC AMOS-B99O6) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: NC 5015004) | |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2024-03-25 |