| NPI | 1235821166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2024000248) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR 224090) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2024-07-14 |