| NPI | 1518690502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IA A169878) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA A169878) |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2022-09-02 |