| NPI | 1629003793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA AP04892) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA RN099206) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2023-05-03 |