| NPI | 1922353200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 0991299-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP06986) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2015-07-06 |