| NPI | 1578273017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R189170) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD R189170) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11022989) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MD R189170) | |
| Enumeration Date | 2022-11-23 |
| Last Update Date | 2024-12-11 |