| NPI | 1104419894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC F01210287) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC F01210287) |
| Enumeration Date | 2021-02-15 |
| Last Update Date | 2023-02-23 |