| NPI | 1962145094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MD R215338) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD R215338) |
| Enumeration Date | 2022-04-17 |
| Last Update Date | 2022-04-17 |