| NPI | 1679935514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5017901) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 20059) |
| Enumeration Date | 2016-03-21 |
| Last Update Date | 2024-02-27 |