| NPI | 1699164202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 147824) |
| Additional Taxonomies | 261QA0005X Clinic/Center, Ambulatory Family Planning Facility (Licence: CA 583861) |
| 261QA0005X Clinic/Center, Ambulatory Family Planning Facility (Licence: AZ 147824) | |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2015-04-07 |