| NPI | 1649380940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 810054) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MS R810054) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2024-05-09 |