| NPI | 1316341472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201503093NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP7384) |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2017-04-11 |