| NPI | 1275061657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AR A006085) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R089860) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2019-01-28 |