| NPI | 1306570163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP027055) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: PA RN749927) |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2023-02-03 |