| NPI | 1457820037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 219518) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 9022501-4405) |
| 363L00000X Nurse Practitioner (Licence: CA 95010198) | |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2018-11-23 |