| NPI | 1174389480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MD R220555) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD R220555) |
| Enumeration Date | 2024-02-23 |
| Last Update Date | 2024-07-07 |