| NPI | 1598408437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ 274225) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: OH RN.485464) |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2023-04-24 |