| NPI | 1922548494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: ID 60867) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MT APRN-131643) |
| 363LF0000X Nurse Practitioner Family (Licence: NM CNP-03175) | |
| Enumeration Date | 2017-03-03 |
| Last Update Date | 2019-06-11 |