| NPI | 1720225949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5004268) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 204378) |
| 363L00000X Nurse Practitioner (Licence: NC 5004268) | |
| Enumeration Date | 2009-01-09 |
| Last Update Date | 2025-03-27 |