| NPI | 1548820574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: AZ 279118) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 12.008266) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2023-09-26 |