| NPI | 1548526759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MT 72263) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4146) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2014-11-21 |