| NPI | 1841666344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 6573) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: WI 6573) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2021-05-20 |