| NPI | 1710577259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021029688) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2014033861) |
| 363LF0000X Nurse Practitioner, Family (Licence: KS 5380433) | |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2022-09-28 |