| NPI | 1396941522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR A01909) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AR A001909) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2020-04-07 |