| NPI | 1831882786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MO 2023023144) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2017035413) |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2023-06-17 |