| NPI | 1073182085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL 11013617) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: FL 11013617) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2021-06-23 |