| NPI | 1679518823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP04519) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA RN095042) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2023-02-17 |