| NPI | 1881030781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4985) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 338315) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2016-09-20 |