| NPI | 1699487512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 14646-33) |
| Additional Taxonomies | 163WU0100X Registered Nurse, Urology (Licence: WI 242459-30) |
| Enumeration Date | 2022-12-22 |
| Last Update Date | 2023-12-07 |