| NPI | 1821641788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: SD CP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MN 6981) |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2020-10-07 |