| NPI | 1124766878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 70414) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 70414) | |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2024-02-15 |