| NPI | 1417372558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR A004008) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 20679) |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2019-04-07 |