| NPI | 1639486665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR A003643) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO NP-990020) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2014-12-09 |