| NPI | 1558856534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-57744) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9414225) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60962413) | |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2020-03-02 |