| NPI | 1891348926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A155117) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SD CP001605) |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2021-06-08 |