| NPI | 1477541779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 11846) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL NP3029682) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 149084) | |
| 363L00000X Nurse Practitioner (Licence: NC 005002286) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2022-11-30 |