| NPI | 1114368511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2016004506) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP07350) |
| Enumeration Date | 2013-07-13 |
| Last Update Date | 2016-05-03 |