| NPI | 1588421663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2024010299) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2024010299) |
| Enumeration Date | 2024-03-05 |
| Last Update Date | 2024-04-25 |