| NPI | 1497945091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 5662905-4405) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024167553) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9308320) | |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2022-11-03 |