| NPI | 1689314478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 5016592) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC KOEL-9TZ) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2022-11-09 |