| NPI | 1912569351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: ID 56339) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID 56339) |
| Enumeration Date | 2019-07-06 |
| Last Update Date | 2021-11-23 |