| NPI | 1912478116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2018025384) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2018025384) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2023-05-09 |