| NPI | 1639160997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-1691) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024166027) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2015-10-23 |