| NPI | 1831973189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 67151) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 67151) |
| Enumeration Date | 2023-08-18 |
| Last Update Date | 2023-09-28 |