| NPI | 1033587860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR A004560) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2015032213) |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2015-11-05 |