| NPI | 1184269532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2019035277) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2019035277) |
| Enumeration Date | 2019-11-08 |
| Last Update Date | 2023-03-02 |