| NPI | 1134781453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC F07190515) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NC F07190515) |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2022-08-15 |