| NPI | 1568960664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2017041065) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 77957) |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2023-01-24 |