| NPI | 1790417871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP025967) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP025967) |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2022-09-16 |