| NPI | 1073197471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IA A163541) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA 00000000) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2025-03-24 |