| NPI | 1629539978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-136070) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-136070) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2021-09-21 |