| NPI | 1447671060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2013043097) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 76189) |
| Enumeration Date | 2013-12-27 |
| Last Update Date | 2013-12-27 |