| NPI | 1417338930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R216085) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: MD R216085) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2024-06-12 |