| NPI | 1659709574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 0990954) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA GAA-NP001776) |
| 363L00000X Nurse Practitioner (Licence: NM 70369) | |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2024-06-14 |