| NPI | 1851027502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 79020) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 13080) |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2024-10-15 |