| NPI | 1184923450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 1204) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024169236) |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2020-04-21 |