| NPI | 1538735378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2021043561) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR 216077) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2022-02-10 |