| NPI | 1679747646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NM 66190) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP2827282) |
| 363LF0000X Nurse Practitioner Family (Licence: FL 2827282) | |
| Enumeration Date | 2008-04-21 |
| Last Update Date | 2023-09-08 |