| NPI | 1790452977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE 113771) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NE 113771) |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2023-05-24 |