| NPI | 1881891083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP009380) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE LG0000442) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2024-06-13 |