| NPI | 1649694217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71004801A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CA 95008674) |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2022-08-04 |