| NPI | 1932436698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM CNP-02430) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO NP-10153) |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2024-03-01 |