| NPI | 1801292677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9464385) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD R177594) |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2023-08-16 |