| NPI | 1639193022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP03989) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA AP03989 RN075005) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2023-07-19 |