| NPI | 1265981856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2106034346) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2106034346) |
| Enumeration Date | 2016-09-24 |
| Last Update Date | 2016-12-13 |