| NPI | 1659978609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC APN.26071) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI 3053) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5016379) | |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2023-01-30 |