| NPI | 1518313311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD AC001802) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DE lg0000928) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2019-08-28 |