| NPI | 1851393920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 28968) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC 28968) |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2025-01-15 |