| NPI | 1093790503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-648) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN092969) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2020-08-04 |