| NPI | 1649236050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-2936) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024165274) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2020-09-23 |