| NPI | 1740510452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NM 55252) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 268036) |
| Enumeration Date | 2009-12-30 |
| Last Update Date | 2020-11-27 |