| NPI | 1952322497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APN000904) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA UP005949B) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2018-03-29 |