| NPI | 1417351842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OR 10006650) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL ARNP9206833) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2023-10-27 |