| NPI | 1841997574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11024566) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PR 4541) |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2023-03-19 |