| NPI | 1326575069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 902196) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 892107) |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2018-03-17 |