| NPI | 1194273466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-104745) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MT NUR-RN-LIC-39831) |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2020-05-04 |