| NPI | 1699384321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 60648) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024188999) |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2024-06-18 |