| NPI | 1376187799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 181858) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 903565) |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2021-11-22 |