| NPI | 1700430113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 62271) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: ID 62271) |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2019-07-25 |