| NPI | 1093110231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 27603) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA 299411) |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2023-07-19 |