| NPI | 1902144991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AR A003845) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AR R080620) |
| Enumeration Date | 2013-01-25 |
| Last Update Date | 2016-05-17 |