| NPI | 1659709848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 6888040-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201393836NP-PP) |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2018-10-18 |