| NPI | 1801889514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA VP002132C) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA VP002132C) |
| Enumeration Date | 2005-08-27 |
| Last Update Date | 2016-03-04 |