| NPI | 1851805477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 72177) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10800) |
| Enumeration Date | 2017-11-17 |
| Last Update Date | 2023-05-09 |