| NPI | 1215563564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5015734) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 5015734) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11006161) | |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2023-02-20 |