| NPI | 1396458543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP026695) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704420109) |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN2322768) | |
| Enumeration Date | 2023-01-03 |
| Last Update Date | 2024-09-16 |