| NPI | 1679233134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 2361278) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 10808238-4405) |
| Enumeration Date | 2021-12-26 |
| Last Update Date | 2025-01-15 |