| NPI | 1982118592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 21389) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 21389) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2024-11-06 |