| NPI | 1821351438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 264355) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1175A) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2017-02-07 |