| NPI | 1427571371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 112285) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA H135465) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2018-03-09 |