| NPI | 1609865740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9429604) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F302269-1) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 14889) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2022-12-16 |