| NPI | 1841741030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2018037132) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2001004428) |
| Enumeration Date | 2016-10-22 |
| Last Update Date | 2023-06-28 |