| NPI | 1164949145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2010031892) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2010031892) |
| 163W00000X Registered Nurse (Licence: KS 14-141112-051) | |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2022-07-21 |