| NPI | 1689962730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA AP06696) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA TAP002648) |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2023-02-13 |