| NPI | 1457854796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 21769) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 212526) |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2024-04-10 |