| NPI | 1861018848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD r277378) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MD R277378) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2020-07-27 |