| NPI | 1114300845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 19769) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 209578) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2023-03-17 |