| NPI | 1023725363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 818580) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11022837) |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2024-04-04 |