| NPI | 1477841567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ 260706) |
| Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: WI 157909-030) |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2021-07-09 |