| NPI | 1841710118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11024993) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 7771-33) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2024-01-22 |