| NPI | 1114554979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE 113385) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 74798) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2023-04-20 |