| NPI | 1578196291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 078405-23) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NH 078405-21) |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2021-03-17 |