| NPI | 1649543257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: PA SP028838) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WA AP60295380) |
| Enumeration Date | 2012-02-13 |
| Last Update Date | 2024-02-09 |