| NPI | 1376274738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5016414) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 146987) |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2022-06-23 |