| NPI | 1760189237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10011420) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 13532) |
| Enumeration Date | 2023-02-14 |
| Last Update Date | 2023-09-06 |