| NPI | 1205315900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR A005824) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AR A005824) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2022-12-20 |