| NPI | 1790443497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 266289) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 848565) |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2022-02-23 |