| NPI | 1518422690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2019002624) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-78539-102) |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2022-10-26 |