| NPI | 1285250670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-140157) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL F06200571) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2022-11-07 |