| NPI | 1508511015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ 298086) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95020022) |
| 363LF0000X Nurse Practitioner Family (Licence: CA 95020022) | |
| Enumeration Date | 2022-02-14 |
| Last Update Date | 2024-04-15 |