| NPI | 1215419379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5010933) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 5010933) |
| 207Q00000X Family Medicine (Licence: NC F08181168) | |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2020-09-10 |