| NPI | 1942040969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2024031599) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2019026701) |
| Enumeration Date | 2024-05-28 |
| Last Update Date | 2024-08-21 |