| NPI | 1235413071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2011034132) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-75495-082) |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2017-10-13 |