| NPI | 1316930050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71001455A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MT NUR-APRN-LIC-100819) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2022-05-05 |