| NPI | 1174191928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE F03210054) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 80625) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2021-06-16 |