| NPI | 1609131358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R857999) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: MS R857999) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2020-04-01 |