| NPI | 1780823559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 1999138409) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP028326) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: DE LP-0010531) | |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2026-01-15 |