| NPI | 1952534422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 18360) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2009022049) |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2024-05-07 |