| NPI | 1205224870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR A004285) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR ATP000731) |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2022-12-07 |