| NPI | 1528701877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 13146) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 13146-33) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2022-10-04 |