| NPI | 1457695306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MD R216739) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R216739) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 61259) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2022-11-07 |