| NPI | 1699713867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 44490) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95141447) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2018-10-30 |