| NPI | 1033644554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: MD R209821) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R209821) |
| 207QA0401X Family Medicine Addiction Medicine (Licence: MD XG4336702) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: MD R209821) | |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2023-03-07 |