| NPI | 1780195669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2017035516) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2017035516) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2025-01-07 |