| NPI | 1629182795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NM CNP01162) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NM R47487) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2016-05-26 |