| NPI | 1831662048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 22495) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 22495) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5015851) | |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2022-04-21 |