| NPI | 1992153845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2016017865) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO F0516669) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2021-03-03 |