| NPI | 1609523380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: SC 27449) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NC 5015877) |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2024-01-16 |