| NPI | 1700844529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 238333) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP8055) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 102440-030) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2022-04-26 |