| NPI | 1275916785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: UT 6771305-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WA AP60573923) |
| 363LF0000X Nurse Practitioner Family (Licence: OR 201607350NP-PP) | |
| 363LF0000X Nurse Practitioner Family (Licence: ID 66093) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2022-09-23 |