| NPI | 1336819481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 11603) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-80529-082) |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2023-06-28 |