| NPI | 1437500972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND R47277) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2016009885) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2023-07-25 |