| NPI | 1518495167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A149054) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SD R044544) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2022-07-21 |