| NPI | 1952036261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 12935592-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN278964) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2023-10-19 |