| NPI | 1568292373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 15433-33) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 15433-033) |
| Enumeration Date | 2024-08-06 |
| Last Update Date | 2024-09-10 |