| NPI | 1063909398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MD R193259) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DE LP-0010374) |
| 363L00000X Nurse Practitioner (Licence: MD R193259) | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2020-08-04 |