| NPI | 1629848114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL 11034634) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: FL RN9437075) |
| Enumeration Date | 2024-01-05 |
| Last Update Date | 2024-08-10 |