| NPI | 1417620618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WY 50974) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: WY 40289) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2023-02-14 |