| NPI | 1285267476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 212199) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 903802) |
| Enumeration Date | 2020-02-17 |
| Last Update Date | 2022-04-07 |