| NPI | 1750788360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71005336A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 3009066) |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2016-12-06 |