| NPI | 1790489029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 070922-23) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NH 070922-21) |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2023-05-05 |