| NPI | 1407286438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MO 2013037113) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KS 53-76080-071) |
| 363LF0000X Nurse Practitioner Family (Licence: IA A153098) | |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2021-01-11 |