| NPI | 1447713649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 61012) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 202003838NP) |
| Enumeration Date | 2019-04-13 |
| Last Update Date | 2025-01-03 |