| NPI | 1114652765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NV 851962) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NV 851962) |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2022-08-03 |