| NPI | 1811558455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: AL CNP241023) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-141847) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2024-05-28 |