| NPI | 1710379862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN 121) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN CNP 0121) |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2025-11-10 |