| NPI | 1578955019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F341255-1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95002352) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA 60528082) | |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2017-01-04 |