| NPI | 1487257622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11008072) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024180530) |
| Enumeration Date | 2020-11-19 |
| Last Update Date | 2022-02-17 |