| NPI | 1609155829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 257390/5006904) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F336824-1) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2016-02-01 |