| NPI | 1386607026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 12712346-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID 54730) |
| 363L00000X Nurse Practitioner (Licence: WA AP30006192) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2022-05-06 |