| NPI | 1801888466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: WI 2287) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 109485) |
| 363L00000X Nurse Practitioner (Licence: WI 2287) | |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2023-10-26 |