| NPI | 1922025790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NE 110386) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NE 110386) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2023-10-18 |