| NPI | 1710345509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 068245-23) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NH 068245-21) |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2025-01-28 |