| NPI | 1538845847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 54661) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM 54661) |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2024-07-02 |