| NPI | 1760044762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5011944) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 5011944) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2024-07-22 |