| NPI | 1942974977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11014510) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 11014510) |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2022-12-02 |