| NPI | 1164199766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R216097) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R216097) |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2021-08-23 |