| NPI | 1437533270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 6152291-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP7939) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2019-03-01 |