| NPI | 1013966225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NV 002605) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 429409) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2024-11-13 |