| NPI | 1184854291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NC 5004396) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NC 207061 (RN)) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2021-03-31 |