| NPI | 1265090138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 3-000625) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2019011519) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2021-10-27 |