| NPI | 1538887971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NH 089401-23) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 129041) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2023-10-19 |