| NPI | 1134482755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: HI 3540) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 3007618) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2022-07-18 |