| NPI | 1508477316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A160340) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AK 202422) |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2024-07-22 |