| NPI | 1336790492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MI 4704305785) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WI 10119-33) |
| 363LF0000X Nurse Practitioner Family (Licence: WI 4704305785) | |
| Enumeration Date | 2019-09-20 |
| Last Update Date | 2021-10-06 |