| NPI | 1902490592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 67222) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 202101983NP-PP) |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2022-03-15 |