| NPI | 1811278872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A132444) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 75481) |
| Enumeration Date | 2011-09-05 |
| Last Update Date | 2020-05-28 |