| NPI | 1760009518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: CA 95028376) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: RI APRN02271) |
| Enumeration Date | 2020-06-28 |
| Last Update Date | 2024-10-07 |