| NPI | 1396200341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 10954) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP11801) |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2024-05-24 |