| NPI | 1144081613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 002418816) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95027897) |
| Enumeration Date | 2024-01-22 |
| Last Update Date | 2024-03-11 |