| NPI | 1992416267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP026995) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: PA RN654261) |
| Enumeration Date | 2022-12-07 |
| Last Update Date | 2023-02-15 |