| NPI | 1386198406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2012004415) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2016016593) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2025-09-03 |