| NPI | 1184987042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NC 5013959) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner Community Health (Licence: CA 21573) |
| 363LF0000X Nurse Practitioner Family (Licence: CA 21573) | |
| Enumeration Date | 2012-06-16 |
| Last Update Date | 2023-03-07 |