| NPI | 1356986053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-150675) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-150675) |
| Enumeration Date | 2019-11-17 |
| Last Update Date | 2022-01-06 |