| NPI | 1558039420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 65237) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM F08211209) |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2024-10-14 |