| NPI | 1265175095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 66935) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 265925) |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2022-04-19 |