| NPI | 1760051106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11013500) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 0000029647) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2021-06-23 |