| NPI | 1073068078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 202101566) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP8638) |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2023-02-16 |