| NPI | 1326600867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 5011923) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC F03190181) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5013840) | |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2023-04-19 |