| NPI | 1659697365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM CNP-01616) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM R49825) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2023-10-16 |