| NPI | 1437585155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: UT 6594212-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: OR 201393323NP-PP) |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2018-11-26 |