| NPI | 1548253644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 222) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI 1757) |
| 363LF0000X Nurse Practitioner, Family (Licence: SC F222) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2020-11-18 |