| NPI | 1427486190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: GA RN081322) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CA 23819) |
| 363LF0000X Nurse Practitioner Family (Licence: MO 2018012958) | |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2019-11-08 |