| NPI | 1174220321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A173106) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA A173106) |
| Enumeration Date | 2023-02-08 |
| Last Update Date | 2023-03-17 |