| NPI | 1528403532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 18218) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 225875) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2023-07-19 |