| NPI | 1598144248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5008269) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA RN605985) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2016-01-21 |