| NPI | 1730588096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-02518) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA 60474380) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2016-06-27 |