| NPI | 1659651172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ AP4637) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: UT 6170200-4405) |
| 363LF0000X Nurse Practitioner Family (Licence: OR 201150077NP) | |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2024-02-06 |