| NPI | 1194477620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MT NUR-APRN-LIC-217325) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-217325) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2023-09-07 |