| NPI | 1902634397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO Q024028936) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID 76054) |
| Enumeration Date | 2024-07-25 |
| Last Update Date | 2024-08-07 |