| NPI | 1619368586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP08196) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 902963) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2019-06-18 |