| NPI | 1568669877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MT 100543) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MT 29052) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2023-11-27 |