| NPI | 1619311974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND R42548) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ TAP4963) |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 7013719-4405) | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2023-12-28 |