| NPI | 1730559790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 282918) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP8198) |
| Enumeration Date | 2015-10-03 |
| Last Update Date | 2018-09-07 |