| NPI | 1790988319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AR A004598) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WI 3167-033) |
| Enumeration Date | 2007-06-10 |
| Last Update Date | 2022-07-21 |