| NPI | 1679050223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 902790) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 902790) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2024-12-11 |