| NPI | 1932522547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A115359) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA 11539) |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2020-11-11 |