| NPI | 1831444686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OR 201250216NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: OR 201240988RN) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2021-08-18 |