| NPI | 1811251234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9469490) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: KY 3007436) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2017-12-01 |