| NPI | 1598425464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: MS 874737) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS PLUN-3NRJ5C) |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2021-12-20 |