| NPI | 1225615172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5018326) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 10979-33) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2023-08-17 |