| NPI | 1215158977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 201285) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 201285) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2017-11-21 |