| NPI | 1932588241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-117714) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5020785) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2024-10-17 |