| NPI | 1780785949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA H163151) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 45550) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2021-07-07 |