| NPI | 1912595778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2020033730) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 66030) |
| 363LF0000X Nurse Practitioner, Family (Licence: AR 214523) | |
| 363LF0000X Nurse Practitioner, Family (Licence: KS 5380251102) | |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2022-03-14 |