| NPI | 1114513223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD PENDING) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD RI82399) |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R182399) | |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2022-01-11 |