| NPI | 1265187082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 25946) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC F01220897) |
| Enumeration Date | 2022-02-21 |
| Last Update Date | 2022-04-01 |