| NPI | 1003538851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 226932) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 280972) |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2022-12-15 |