| NPI | 1184122376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R203259) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD R203259) |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2023-04-19 |