| NPI | 1578665121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY F335247-1) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R157969-5) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2017-02-28 |