| NPI | 1649784984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AL 1-103117) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: GA RN273998) |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2019-06-21 |