| NPI | 1700669942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP028151) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: PA RN735157) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2024-05-08 |