| NPI | 1548881469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 64117) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ RNP240774) |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2021-09-10 |