| NPI | 1225741762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5017523) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: NC 5017523) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 5017523) | |
| Enumeration Date | 2022-12-29 |
| Last Update Date | 2024-01-25 |