| NPI | 1689312787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2022021020) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2022013516) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MO 2018007575) | |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2022-06-13 |