| NPI | 1700275443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2014039301) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 76633) |
| Enumeration Date | 2015-01-19 |
| Last Update Date | 2015-01-30 |