| NPI | 1073006862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD r195453) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DE LG-0011834) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R195453) | |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2021-12-16 |