| NPI | 1992081467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP1527A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SD CP000676) |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2021-08-18 |