| NPI | 1821419094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AR A004003) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R74308) |
| Enumeration Date | 2013-12-13 |
| Last Update Date | 2019-09-19 |