| NPI | 1548641970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F342959) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 95829) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2022-05-09 |