| NPI | 1558615997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5005918) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5005918) |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2023-12-18 |