| NPI | 1841236577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5003865) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 2033) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2019-02-12 |