| NPI | 1780332890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR 218963) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2024017560) |
| Enumeration Date | 2022-03-17 |
| Last Update Date | 2024-07-03 |