| NPI | 1497250542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R242732) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV aprn002880) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2021-09-02 |