| NPI | 1790746303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 048292-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 048292-23-03) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2023-03-07 |