| NPI | 1700267507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 841-13229) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AL 1-136329) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2023-03-21 |