| NPI | 1982193413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM CNP-03576) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NM CNP-03576) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2020-09-01 |