| NPI | 1760442537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KS 45763) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: KS 74541) |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2018-12-13 |