| NPI | 1124745260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ 243298) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 243298) |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2023-06-12 |