| NPI | 1871112235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-147321) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-147321) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2022-02-23 |