| NPI | 1750954111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A164307) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID 69397) |
| Enumeration Date | 2021-07-22 |
| Last Update Date | 2022-12-14 |