| NPI | 1043883903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5014757) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC MCCA-N69KR) |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2023-09-01 |