| NPI | 1568077501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11009159) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11009159) |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2023-05-09 |