| NPI | 1649043795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A177932) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 164170) |
| Enumeration Date | 2023-10-31 |
| Last Update Date | 2024-02-02 |