| NPI | 1801835038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AR A01784) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AR R71092) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2011-11-08 |