| NPI | 1780242412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 23487) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: GA RN264549) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2022-11-08 |