| NPI | 1912097056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 3589) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 3589) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA 158833) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201050188NP) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2022-01-11 |