| NPI | 1982672655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A136409) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MT 38495) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2024-07-27 |