| NPI | 1346950193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 26971) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 236885) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-12-02 |
| Last Update Date | 2023-01-18 |