| NPI | 1316993546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MT NUR-APRN-LIC-216717) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 201395) |
| 363L00000X Nurse Practitioner (Licence: ID NP-1578A) | |
| 363LF0000X Nurse Practitioner Family (Licence: NC 201395) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2023-11-09 |