| NPI | 1447654942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD AC001392) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024171748) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2023-03-14 |