| NPI | 1588494959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID 4161178) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID NA) |
| Enumeration Date | 2024-08-01 |
| Last Update Date | 2024-08-29 |