| NPI | 1881978229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5005307) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 092767-23) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2023-12-08 |