| NPI | 1225456304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP07641) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID 63614) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2023-02-06 |