| NPI | 1619719929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2024027857) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 5383612) |
| Enumeration Date | 2024-06-07 |
| Last Update Date | 2024-12-02 |