| NPI | 1992298665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-03600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM CNP-03600) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2021-12-10 |