| NPI | 1376311134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WV 117720) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: PA SP023030) |
| Enumeration Date | 2023-12-12 |
| Last Update Date | 2024-02-07 |