| NPI | 1972865764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R171488) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: MD M-610-132-631-954) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2021-04-23 |