| NPI | 1427672682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5013219) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 263240) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2022-12-20 |