| NPI | 1255919452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NC 5014266) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5014266) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2022-08-25 |