| NPI | 1811580566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2020026387) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: MO 2020026387) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2020026387) | |
| Enumeration Date | 2021-02-13 |
| Last Update Date | 2021-02-13 |