| NPI | 1245705748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5014382) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP019375) |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2024-02-16 |