| NPI | 1255066767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: WI 11967) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 11967-33) |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2023-05-25 |