| NPI | 1508196718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: UT 9171990-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM CNP-01516) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP7919) | |
| Enumeration Date | 2010-01-11 |
| Last Update Date | 2021-03-22 |