| NPI | 1881229508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5012952) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC APN.23665) |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2022-06-21 |