| NPI | 1184047730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AR A004077) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AR ATP-000613) |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2024-03-07 |