| NPI | 1326888330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND R49142) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ND R49142) |
| Enumeration Date | 2024-05-28 |
| Last Update Date | 2024-06-26 |