| NPI | 1366102253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR 218019) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA 223761) |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2023-06-20 |