| NPI | 1437627320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 22162) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 22162) |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2024-11-15 |