| NPI | 1952974057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MT 177401) |
| Additional Taxonomies | 282NR1301X General Acute Care Hospital, Rural (Licence: MT F06212305) |
| 207Q00000X Family Medicine (Licence: MT F06212305) | |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2022-09-01 |