| NPI | 1902361611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 22319) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 22319) |
| Enumeration Date | 2019-02-06 |
| Last Update Date | 2021-01-28 |