| NPI | 1992317366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 24395) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 208066) |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2021-09-02 |