| NPI | 1497400170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: WI 11761-33) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 11761-33) |
| Enumeration Date | 2022-02-21 |
| Last Update Date | 2022-02-21 |