| NPI | 1194022046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 20843) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP011089) |
| Enumeration Date | 2011-02-11 |
| Last Update Date | 2021-11-22 |