| NPI | 1144745365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NC 5010984) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IL 209.016266) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2022-11-10 |