| NPI | 1316646557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5018650) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 27102) |
| Enumeration Date | 2023-02-27 |
| Last Update Date | 2023-10-17 |