| NPI | 1538689260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP09446) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA RN134485) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2019-06-12 |