| NPI | 1801177985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP06649) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MS 889890) |
| 363LF0000X Nurse Practitioner, Family (Licence: MS 889890) | |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2021-09-27 |