| NPI | 1588159628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 21999) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5011706) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2022-10-26 |