| NPI | 1962844522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR A004043) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2013026042) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2024-09-12 |