| NPI | 1669821047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AR A005655) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KS 77258) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2018-10-30 |