| NPI | 1477627917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 213811-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP5189) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2023-11-27 |