| NPI | 1376898965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK 114963) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 100637) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 041.372410) | |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2023-05-09 |