| NPI | 1558765131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5012543) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS R882894) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60642226) | |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2020-08-11 |