| NPI | 1093248718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 291932) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 291932) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2022-01-27 |