| NPI | 1104371467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021020879) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NE 112088) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2021-09-17 |