| NPI | 1700383007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MS 902529) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 902529) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2018-05-21 |