| NPI | 1689014862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9485401) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP017792) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: DE LP-0000214) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 308308) | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2022-12-01 |