| NPI | 1588181051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2016019534) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2009003957) |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2017-08-25 |