| NPI | 1487178844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 21193) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 96804) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2024-02-19 |