| NPI | 1891233037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 251527) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 345031) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2022-03-14 |