| NPI | 1508368820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 65612) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 23710) |
| 363L00000X Nurse Practitioner (Licence: TN 23710) | |
| Enumeration Date | 2018-03-02 |
| Last Update Date | 2023-06-22 |