| NPI | 1629070297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 344384) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SD R038406ANDCP000642) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201802902NP-PP) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2019-10-24 |