| NPI | 1487360426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5018014) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC f10220574) |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2023-07-18 |