| NPI | 1215399597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 219166) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71006126A) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2019-01-07 |