| NPI | 1629254255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP03296) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA AP03296) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2020-10-15 |