| NPI | 1174603401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NH 071406-23) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 217496) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2024-07-19 |