| NPI | 1730427014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-02364) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 264709) |
| 363LF0000X Nurse Practitioner, Family (Licence: SC APRN-18171) | |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2018-05-30 |