| NPI | 1629386347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-169017) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA f0710432) |
| 363L00000X Nurse Practitioner (Licence: LA rn113393-apo6243) | |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2023-09-06 |