| NPI | 1063070241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NM 59398) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AZ 226715) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2021-08-27 |