| NPI | 1407456668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 77052) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 248862) |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2023-08-04 |