| NPI | 1588348858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71014187A) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: NY F320102-01) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2023-09-26 |