| NPI | 1083215255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5013795) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC MELT-9G8VO) |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2022-08-17 |