| NPI | 1457983785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2020002316) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2020002316) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2021-03-02 |