| NPI | 1639825979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 27729) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2022004331) |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2024-01-03 |