| NPI | 1306396676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL F08161087) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-124207) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2016-10-10 |