| NPI | 1548516966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 178477-30) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 2548) |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2022-06-27 |