| NPI | 1073035168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 902114) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR A005207) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2022-07-17 |