| NPI | 1396948402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA AP05193) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: LA AP05193) |
| 363LF0000X Nurse Practitioner, Family (Licence: LA AP05193) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2025-05-20 |