| NPI | 1174537849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 110342) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NE 110342) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2021-09-15 |