| NPI | 1720797822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61376005) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO C-RXN.0002570-C-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: VT 101.0135762PROV) | |
| Enumeration Date | 2022-11-16 |
| Last Update Date | 2023-09-27 |