| NPI | 1649327156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 1461) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC RX1461) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2021-08-25 |