| NPI | 1619900339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APN000990) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 2047224405) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2014-12-05 |