| NPI | 1578279162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 27658) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 234194) |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2023-07-20 |