| NPI | 1528510898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WA 61004280) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP131522) |
| 363LF0000X Nurse Practitioner Family (Licence: GA RN188920) | |
| Enumeration Date | 2016-11-02 |
| Last Update Date | 2021-01-19 |