| NPI | 1619325966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 9389648) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: FL 9389648) |
| 363LF0000X Nurse Practitioner Family (Licence: FL 9389648) | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2022-10-07 |