| NPI | 1740913904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 13049-033) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 193744-30) |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 13049-33) | |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2022-11-30 |