| NPI | 1487877296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP3009) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F334791-1) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2018-03-28 |