| NPI | 1841520848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-03204) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 23144) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2020-07-21 |