| NPI | 1851081921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 14178) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 223971-30) |
| Enumeration Date | 2023-05-11 |
| Last Update Date | 2023-10-30 |