| NPI | 1861766206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA AP06784) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA AP06784) |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2017-03-15 |