| NPI | 1780340851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 189031) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AK 123046) |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2022-02-03 |