| NPI | 1699261818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND 5010680) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5010680) |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2019-05-22 |