| NPI | 1538669189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR 124264) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2018004598) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2024-11-11 |