| NPI | 1518400720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 6349207-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 6439207-4405) |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2018-03-17 |