| NPI | 1740463876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-03469) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM R60407) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2018-11-06 |