| NPI | 1205616463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5020388) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 158688) |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2024-08-29 |