| NPI | 1174176812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 11399-33) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024177643) |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 21255-875) | |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2024-01-18 |