| NPI | 1578793725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5004456) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 190386) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2022-07-21 |