| NPI | 1588063390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 5978) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 173153-30) |
| 363L00000X Nurse Practitioner (Licence: WI 5978-33) | |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2024-10-03 |