| NPI | 1992112635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: ND R31691) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ND R31691) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2015-12-24 |