| NPI | 1285056234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MT 100503) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MT 28349) |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2023-11-27 |