| NPI | 1598364838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ 249166) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ 249166) |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2023-11-03 |