| NPI | 1356035802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR 225507) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R107150) |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2023-07-11 |