| NPI | 1720548027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI 2739) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI R-85336) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2023-03-21 |