| NPI | 1538610001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5023251) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9180843) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2025-12-10 |