| NPI | 1427568393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE 112354) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 75939) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2021-11-23 |