| NPI | 1073050845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL ARNP3048142) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP3048142) |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2022-08-10 |