| NPI | 1245877224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AR 124247) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AR 124247) |
| Enumeration Date | 2019-12-09 |
| Last Update Date | 2025-08-18 |