| NPI | 1447892021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2019021620) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 5381389) |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2022-07-28 |