| NPI | 1154979938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2019032538) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MO 2004024273) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2004024273) | |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2020-02-05 |