| NPI | 1639504871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201603408NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-78103) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0990879-NP) | |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2021-03-17 |