| NPI | 1598312498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R215347) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95012535) |
| Enumeration Date | 2019-08-25 |
| Last Update Date | 2024-10-29 |