| NPI | 1639302789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024168401) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: VA 0024168401) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2019-11-04 |