| NPI | 1588077820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MS R890339) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS R890339) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2014-09-02 |