| NPI | 1083138226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP09479) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 902063) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2022-07-21 |