| NPI | 1235515545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WI 7313-33) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WA AP60598599) |
| 363LF0000X Nurse Practitioner Family (Licence: IL 209013034) | |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2020-06-26 |