| NPI | 1518959535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: UT 261539-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 261539-4405) |
| 363L00000X Nurse Practitioner (Licence: CO 115014) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2021-09-09 |