| NPI | 1356698328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-197363) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-197363) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3007691) | |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2024-08-21 |