| NPI | 1437529633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2015034744) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 77024) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2015-11-06 |