| NPI | 1346501046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: ND R27160) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ND R27160) |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2023-12-26 |