| NPI | 1730712605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 211621) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: LA 211621) |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2023-11-02 |