| NPI | 1174217467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 14053) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 253785) |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2023-07-25 |