| NPI | 1346538212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA AP07737) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP07737) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN169902) | |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2024-04-05 |