| NPI | 1932870524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11015189) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 12835792-4405) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 9863) | |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2023-11-02 |