| NPI | 1407379084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 902212) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MS 895792) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2018-03-17 |