| NPI | 1053730614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-1734) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI NP08) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2024-02-08 |