| NPI | 1972953743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2016016600) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2011002739) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2020-12-22 |