| NPI | 1871290783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR 223630) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0135455) |
| Enumeration Date | 2023-02-10 |
| Last Update Date | 2023-04-05 |