| NPI | 1831165141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5010936) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA 274271) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2021-10-26 |