| NPI | 1851382824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201392935NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60425455) |
| 363LF0000X Nurse Practitioner, Family (Licence: HI APRN - 487) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2016-03-22 |