| NPI | 1396224390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 53771) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM RN-75506) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2021-12-28 |