| NPI | 1083087415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-1901) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: HI APRN-1901) |
| Enumeration Date | 2015-11-06 |
| Last Update Date | 2020-11-29 |