| NPI | 1326762428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 13186-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 154381-30) |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2023-01-11 |