| NPI | 1790542546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MO 2024005952) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KS 53-82939-012) |
| Enumeration Date | 2024-02-28 |
| Last Update Date | 2024-02-28 |