| NPI | 1245712157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5010955) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 343305) |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2022-09-27 |