| NPI | 1295238376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 64775) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP11093) |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2023-06-08 |