| NPI | 1306516513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IA A159408) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NM 65233) |
| Enumeration Date | 2021-09-18 |
| Last Update Date | 2025-06-12 |