| NPI | 1851732655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 6575229-4408) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201390208NP-PP) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2023-11-27 |