| NPI | 1942813662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2020037057) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2013025154) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2021-08-31 |