| NPI | 1598276669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A138315) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IA A138315) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2019-04-03 |