| NPI | 1023105632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NM CNP-03146) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM CNP-03146) |
| 363L00000X Nurse Practitioner (Licence: FL ARNP2742702) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2020-03-13 |