| NPI | 1386003572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 21813) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 684695-1) |
| 363LF0000X Nurse Practitioner Family (Licence: NY F338871-1) | |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2023-07-24 |