| NPI | 1235510058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201900972NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP7996) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2024-10-04 |